Predictive Factors of Epstein-Barr Virus Association in Gastric Adenocarcinoma

BACKGROUND: It is important to detect Epstein-Barr virus (EBV) in the setting of gastric cancer so that early viral targeted therapy and prevention can be undertaken. The aim of this study was to investigate the predictive clinicopathologic factors for EBV-related gastric cancer. METHODS: The archival tumor tissues from 335 patients with gastric cancer were examined using tissue microarray. The detection of EBV was performed using EBV mRNA in situ hybridization (EBV-ISH), and the results were compared against clinicopathologic factors. RESULTS: EBV-related gastric cancers were identified in 21 of 335 investigated cases (6.27%). The anatomical predisposition of EBV-related cancers to manifest in the upper stomach was statistically significant (p<0.001). EBV-related cancers were almost always (20/21) accompanied by lymphoid stroma. No differences in age, sex, histologic differentiation, or T or N stage were noted between EBV-positive and EBV-negative gastric carcinomas. CONCLUSIONS: The association of EBV with gastric adenocarcinomas could be predicted when tumors with lymphoid stroma occurred in the upper stomach.

Mucinous Adenocarcinoma in a Horseshoe Kidney

We report here on a case of mucinous adenocarcinoma that probably originated in the renal pelvis of a horseshoe kidney. A 61-year-old woman presented with a palpable mass in the left upper quadrant of the abdomen, and this mass had been present for several months. Computed tomography (CT) revealed a left renal pelvic tumor in the horseshoe kidney. Grossly, a 10x9x8 cm unilocular cystic mass filled with chocolate colored mucinous fluid was seen. A connection between the cystic mass and the renal pelvis was demonstrated on retrograde pyelography. Microscopically, the cyst contained anaplastic columnar mucosecretory epithelial cells. Some atypical cell clusters were freely floating in the mucinous lakes. The histopathological findings were consistent with mucinous adenocarcinoma. In addition, glandular metaplasia was noted in the cystic wall. Immunohistochemical assessment of the pelvic adenocarcinoma revealed the positive expressions of carcinoembryonic antigen (CEA) and cytokeratin 20 (CK20) and a weak positive expression of cytokeratin 7 (CK7).

Enterogenous Cyst of the Testis

We present a rare case of an enterogenous cyst of the testis in a 21-year-old man. On ultrasonography, an ovoid hypoechoic solid mass (2x2x1.5 cm) was confined to the right testis. The left testis and bilateral epididymis were within normal limits. Grossly, the tumor was a unilocular cystic mass, without a solid component. Microscopically, the cystic mass was composed of mucin-secreting simple columnar epithelial lining cells, lamina propria and a well-differentiated muscularis propria. There was no evidence of any germ cell derivatives or neoplasia in the cystic mass and in the surrounding testicular parenchyma. Immunohistochemistry showed a positive reaction for cytokeratin and the epithelial membrane antigen in the epithelial lining; in addition, it was positive for smooth muscle actin in the well-differentiated muscularis propria.

Diffuse Ganglioneuromatosis of Appendix associated with Von Recklinghausen;s Disease

Gastrointestinal ganglioneuromatosis is a rare neoplastic condition that can occur in association with von Recklinghausen's disease with multiple endocrine neoplasia type II B. The main locations are the ileum, colon, and appendix. We report a case of diffuse ganglioneuromatosis of the appendix associated with a mesenteric and ileocecal plexiform neurofibroma in von Recklinghausen's disease.

Two Cases of Strongyloidiasis Diagnosed by Colonoscopic Biopsy

Strongyloides stercoralis is an intestinal nematode that is able to infect the host tissue and persist for many years through autoinfection, and it causes life-threatening hyperinfection in immunocompromised hosts. We report here on two cases of strongyloidiasis that were diagnosed by colonoscopic biopsy. One case was a 73-year-old woman who was hospitalized with complaints of melena. She was being treated with corticosteroid due to her asthma and rheumatoid arthritis. The other case was a 63-year-old man who suffered with abdominal discomfort and severe loss of body weight (18 kg) for 2 months. In both cases, colonoscopic examination revealed polyps and petechiae at the entire colon. Microscopically, a small illdefined granuloma with a longitudinally sectioned parasite was seen on the colonoscopic biopsy. Endoscopic examination was done after suspecting parasitic infestation. The gastric and duodenal mucosa showed numerous cross sections of adult worms, eggs and larvae that were developing in crypts. Even if such a patient is in an asymptomatic state, this illness must be treated due to the potential for fatal autoinfection.